含甜菜碱型甲基营养素对糖尿病肾病伴HHcy患者肾的保护效应  

Protective effect of methyl nutrient containing betaine on kidney in patients with diabetic nephropathy and hyperhomocysteinemia

作　　者：曾瑶池 李翠玉 宋晓莉 袁瑞[2] 戈娜[3] 魏文婷 Zeng Yaochi;Li Cuiyu;Song Xiaoli;Yuan Rui;Ge Na;Wei Wenting(Department of Nutrition,Shenzhen Traditional Chinese Medicine Hospital,Shenzhen 518033,Guangdong,China;Medical Laboratory,Shenzhen Traditional Chinese Medicine Hospital,Shenzhen 518033,Guangdong,China;Nephrology Laboratory,Shenzhen Traditional Chinese Medicine Hospital,Shenzhen 518033,Guangdong,China)

机构地区：[1]深圳市中医院营养科,广东深圳518033 [2]深圳市中医院检验科,广东深圳518033 [3]深圳市中医院肾病研究室,广东深圳518033

出　　处：《肿瘤代谢与营养电子杂志》2022年第3期320-327,共8页Electronic Journal of Metabolism and Nutrition of Cancer

摘　　要：目的探讨含甜菜碱型甲基营养素对伴有高同型半胱氨酸(HHcy)血症的糖尿病肾病(DKD)患者肾功能及尿微量白蛋白(MA)的作用。方法选取2019年9月至2021年1月就诊的64例DKD合并HHcy患者,随机分为甲基营养素组(n=32)和叶酸甲钴胺组(n=32),干预16周后,比较两组间血糖、血脂、肾功能以及MA等指标的差异。干预效果采用意向性治疗分析集(ITT)进行分析。结果与叶酸甲钴胺组相比,含甜菜碱型甲基营养素组尿素氮(UN)、血肌酐(Scr)、尿酸(UA)、胱抑素C(Cys C)、同型半胱氨酸(Hcy)、尿肌酐(UCr)、MA、β2微球蛋白(Uβ2-MG)、N-乙酰氨基葡萄糖苷酶(NAG)、尿总蛋白(TP-U)水平及尿白蛋白/肌酐比值(ACR)均较对照组下降,均有统计学差异;甲基营养素组估算肾小球滤过率(eGFR)及叶酸(FA)水平上升幅度优于叶酸甲钴胺组,结果均有统计学差异。结论HHcy可能是影响2型糖尿病患者肾功能的因素之一,含甜菜碱型甲基营养素的合理应用可降低Hcy水平、有效保护肾功能,减少MA水平。Objective To explore the effect of betaine-containing methyl nutrients on renal function and urinary microalbuminuria(MA)in patients with diabetic kidney disease(DKD)accompanied by hyperhomocysteinemia(HHcy).Method Sixty-four patients with DKD and HHcy were recruited from Shenzhen Traditional Chinese Medicine Hospital between September 2019 to January 2021.They were randomly divided into methyl nutrient group(n=21)and folate methylcobalamin group(n=32).After 16 weeks of intervention,the differences in blood glucose,blood lipids,renal function and MA and other indicators between the two groups were studied.The treatment effect was represented by intention-to-treat analysis.Result Compared with the folate methylcobalamin group,urea nitrogen(UN),serum creatinine(Scr),uric acid(UA),cystatin C(Cys C),homocysteine(Hcy),urine creatinine(UCr),MA,β2 microglobulin(Uβ2-MG),N-acetylglucosaminidase(NAG),total urinary protein(TP-U)and urinary albumin/creatinine ratio(ACR)were significantly decreased in methyl nutrient group containing betaine.The increase of estimated glomerular filtration rate(eGFR)and folic acid(FA)in estimated glomerular filtration rate in the methyl nutrient group containing betaine were better than the folate methylcobalamin group,with significantly significant differences.Conclusion HHcy may be one of the factors affecting the renal function of patients with T2DM.The reasonable application of betaine-containing methyl nutrients can reduce Hcy levels,effectively protect renal function,and reduce MA levels.

关 键 词：甜菜碱 叶酸 维生素B_(12) 糖尿病肾病 高同型半胱氨酸 肾功能 

分 类 号：R587.2[医药卫生—内分泌] R692.9[医药卫生—内科学] R459.3[医药卫生—临床医学]